W 0000 #IN00342683....to still stand up. 4. What did her vomit look like? Brownish chunks. It was...

(X1) PROVIDER/SUPPLIER/CLIA

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR MEDICARE & MEDICAID SERVICES

01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039

STATEMENT OF DEFICIENCIES

AND PLAN OF CORRECTION IDENTIFICATION NUMBER

(X2) MULTIPLE CONSTRUCTION

A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED

NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP COD

(X4) ID

PREFIX

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SUMMARY STATEMENT OF DEFICIENCIE

(EACH DEFICIENCY MUST BE PRECEDED BY FULL

REGULATORY OR LSC IDENTIFYING INFORMATION

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TAG

IDPROVIDER'S PLAN OF CORRECTION

(EACH CORRECTIVE ACTION SHOULD BE

DEFICIENCY)

(X5)

COMPLETION

DATECROSS-REFERENCED TO THE APPROPRIATE

MERRILLVILLE, IN 46410

15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

W 0000

Bldg. 00

This visit was for the investigation of complaint

#IN00342683.

Complaint #IN00342683: Substantiated, Federal

and state deficiencies related to the allegation(s)

are cited at W149, W192 and W249.

This visit was in conjunction with a predetermined

full recertification and state licensure survey and

the COVID-19 focused infection control survey.

Dates of Survey: December 7, 8, 9, 10, and 14, 2020

Facility Number: 001113

Provider Number: 15G599

Aims Number: 100245610

These deficiencies also reflect state findings in

accordance with 460 IAC 9.

Quality Review of this report completed by #15068

on 12/23/20.

W 0000

483.420(d)(1)

STAFF TREATMENT OF CLIENTS

The facility must develop and implement

written policies and procedures that prohibit

mistreatment, neglect or abuse of the client.

W 0149

Bldg. 00

Based on record review and interview for 1 of 3

sampled clients (client A), the facility failed to

implement its written policies and procedures to

prevent neglect of client A's health care needs.

Findings Include:

The facility's BDDS (Bureau of Developmental

Disabilities Services) reports and related

W 0149W149: The facility currently has a

written policy and procedure on

mistreatment, neglect or abuse of

a client and the reporting there of.

All staff are trained upon hire and

annually in the individual’s specific

needs. In addition, staff are trained

on the policy and the procedure for

reporting illness or injury of the

01/13/2021 12:00:00AM

FORM CMS-2567(02-99) Previous Versions Obsolete

Any defiencystatement ending with an asterisk (*) denotes a deficency which the institution may be excused from correcting providing it is determin

other safegaurds provide sufficient protection to the patients. (see instructions.) Except for nursing homes, the findings stated above are disclosable

following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclo

days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to

continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

_____________________________________________________________________________________________________Event ID: D6TD11 Facility ID: 001113

TITLE

If continuation sheet of 27

(X6) DATE




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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

investigations were reviewed on 12/7/20 at 3:27

pm.

A BDDS report dated 11/27/20 indicated the

following:

"Day Hab PS (Program Supervisor) received call

from 65th staff at 10:23 am stating that [client A]

was sick and not feeling well. Staff reported that

she was weak, pale, and not herself. Staff

reported that the vomit was a chunky brown.

Vitals were taken twice, and, during the 2nd vitals,

she threw up. Staff were cleaning her up and

noticed that she was slumped over and breathing

slow (sic). PS, PD (Program Director), and nurse

were contacted and staff advised to call 911. Staff

called 911 at 11:25 am (sic) was on the phone with

them for 11 mins (minutes) doing CPR

(Cardiopulmonary Resuscitation) until EMTs

(Emergency Medical Technicians) arrived. Upon

arrival, EMTs pumped [client A's] stomach and

worked on her until they got a pulse. EMTs then

took her to the hospital. Report from [client A's]

sister and ER (Emergency Room) nurse: BP (blood

pressure) 80/30, P (pulse) 30, T (temperature) 89.6.

Treatment with warming blanket, IV (intravenous)

fluids, and Dopamine (used to improve blood

flow) to raise BP and pulse. She has pneumonia in

both lungs and is getting IV antibiotics. Her

hemoglobin (the molecule in red blood cells that

carries oxygen) is a 4 but should be at least 12.

Blood is being given. Sister signed a modified

DNR (do not resuscitate). As of 6:00 pm, nurse

reported that temp (temperature): 90.7, BP 85/7?

(sic), and still waiting for results on head/chest,

abdomen scans.

Plan to Resolve (Immediate and Long Term)

Nurse will continue to receive updates from

guardian and hospital on [client A's] condition."

individual’s.

The facility staff will be trained on

individual specific training for all

individuals. This will include risk

protocols. The staff will be trained

to implement the protocol when an

individual is exhibiting symptoms

identified in those risk protocols.

In addition, staff will be trained on

abuse, neglect and mistreatment

policies as well as the protocol to

report incidents of illness

immediately to the nurse and in

911 procedures.

The Program Supervisor will

monitor the documentation

completed by staff 3 times per

week for one month to ensure any

illness or behavioral instances

have been reported per policy.

After that assuming compliance

has been achieved, the Program

Supervisor will monitor

documentation at least 2 times

per week. The Program Director

will monitor documentation two

times weekly for one month to

ensure that illness or incidents

that occur are addressed to

ensure the individual’s needs are

being met in full.

The facility will continue to train all

employees in individual specific

training upon hire and annually

thereafter.as well as when to notify

the nurse of illness and when to

call 911.

FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: D6TD11 Facility ID: 001113 If continuation sheet of 27




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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00


following:

"[Client A] had been in the hospital ICU

(Intensive Care Unit) since 11/28/20. Initial

diagnosis consists of gastrointestinal hemorrhage

type, anemia unspecified type AKI (acute kidney

injury), cardiac arrest, hypotension, unspecified

hypotension type. She was placed on a ventilator

and given IV antibiotics. Labs showed high

potassium, so [client A] was placed on dialysis to

clean blood and urine. EEG

(electroencephalogram) and echo

(echocardiogram) were completed, but no results

given at time of report. COVID test was negative.

Modified DNR (no CPR or shocking) was put in

place. Family requested on 12/1/20 that [client A]

be removed from the ventilator. At time of

removal it was reported that she took 4 short

breaths and passed away at 10:12 pm."

An undated related investigation was reviewed on

12/7/20 at 3:40 pm.

A phone interview with Direct Support

Professional (DSP) #5 dated 11/27/20 at 4:45 pm

indicated the following:

"1. Did your work last night (11/26/20)? Yes

Overnight.

2. How [client A] was (sic) during your shift, was

(sic) there any concerns? When I came in, the

staff before me said that [client A] kept throwing

up, after she ate she would throw up. She was

banging her head and was off balance and

couldn't walk by herself.

3. Did she throw up on your shift? Yes, the whole

night. I had to keep cleaning her up. I realized at

3:45 am that if she sat up she didn't throw up. She

wouldn't stay on the bed, she wanted to stay on

the floor. I made pallets (blankets on the floor)

but that didn't seem to work either as she wanted

Responsible Party: Area Director

Correction Date: 1/13/2020





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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

to still stand up.

4. What did her vomit look like? Brownish

chunks. It was like she was gurgling and blocking

her airway when she was laying down, so I sat her

up.

5. Was anyone notified? I didn't notify on call

because I saw that she had been throwing up for a

couple of days. I took her vitals at 2 or 3 in the

morning. She was sitting right there by her in the

wheelchair (sic). It's not uncommon for her to

throw up at night, as she does that. What was

weird was that she was unbalanced or seemed to

want to harm herself by throwing her head onto

the floor. If she was sitting on the bed, she would

try and throw herself off the bed. I asked her if

she was hurting and she said no.

6. What is the protocol if there are changes in

conditions? Just notify on call. It was 2/3:00 in

the morning, and [client A] didn't seem in distress,

so I just thought I'd call supervisor in the

morning...."

A written statement by DSP #6 dated 11/27/20


"On 11/27/20, Friday, 8:30 am, [DSP #5] was asked

how the night went. She responded that [client

A] was throwing up all night and had no sleep. I

asked her if she called to report it, and she said,

'No, not yet. I'm going to before I leave.' She

went in the back office and then said bye to

everyone as she walked out. I asked, 'Did you call

and report on [client A]?' She said, 'Not yet. I'm

going to right now.'"



"[Client A] was drinking her boost at 8:28 am. She

looked pale, puffy, and exhausted. She was

sitting in her wheelchair. [DSP #5] told us that

[client A] was up all night, no sleep, throwing up





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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

multiple times since yesterday evening, and not

eating/drinking. [Client A] did not finish her

boost and began whining. She joined her peers in

the living room around 9:00 am. She was saying

the word 'tired' a few times in between whines.

She started taking her clothes off and was

wheeled to her room to change clothes. [Client A]

did not want clothes on. She was covered up and

checked on. Just before 10 am, [client A] was

nodding off. She dressed and was wheeled into

the living room. She was not talking or whining.

She would not answer to her name or respond to

touch. She threw up and was cleaned up.

Supervisor was called around 10:15 am. He

advised to take vitals. I looked for the physicians

order while the other staff took vitals. Called

supervisor at 10:35 am to report vitals. Orders

were found in the van. Supervisor called back at

10:50 am to get a second vitals recording. She

threw up again. Vitals were taken, and she was

cleaned up. She was slumped over and breathing

slow (sic). Supervisor called at 11:22 am to call

911. 911 was called immediately. 911 took

information about the house and individual. She

instructed to get [client A] on the floor and begin

CPR. Compressions done for 4-5 minutes.

Medics arrived. Asked her age and hooked her

up to the AED (automated external defibrillator).

They took over and asked what happened. They

asked about medical conditions. [Client A's]

stomach was pumped. They worked on her on the

living room floor until they got a pulse. They

wheeled her out around 12 pm."

A written statement by PD (Program Director ) #1

dated 11/27/20 indicated the following:

"Received call from [supervisor #1] at 10:27 am

stating day service staff at 65th St. group home

are concerned because [client A] was very pale. I

instructed him to get vitals, BP, O2 (oxygen),





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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

temp, height, and weight and call nurse on call.

[Supervisor #1] updated myself after talking to

nurse on call at 11:11 am.

At 11:37 am staff called stated CPR, than (sic)

asked if [client A] has a DNR.

At 11:39 am I contacted [AD (Area Director) #1]

explain that DSPs started CPR on [client A]. [DSP

#6]. Stated I was on my way to the group home.

At 11:38 am I call (sic) nurse on call to inform her

that direct staff was doing CPR.

12 pm I updated [AD #1] that the EMTs got a very

weak heart beat, was (sic) transporting to ER. I

stayed at the house to assist direct staff.

When I arrived at the group home, they were

wheeling her out to the ambulance."

A written statement by DSP #7 was dated 11/27/20


"When arrived at the home at 8:27 am, the

midnight staff [DSP #5] told us that [client A] was

up all night and she was throwing up all night did

(sic) use the bathroom either. I took [client A]

from the kitchen table 8:45 am put her in the living

room with peers. She was in the wheelchair

because she could not walk at all. At 10:15 am,

10:23 am I called [supervisor #1] and told him that

[client A] was very weak, not responding. She

turn (sic) pale and she was not herself. At 10:35

am [supervisor #1] called back and told me to

write the following thing (sic) down. Take temp,

blood pressure, oxygen. Told us to take a picture

of her physician orders (sic) was sent to

supervisor at 11:01 am. Check [client A's]

physician orders check weight and temperature.

At 11:29 am, supervisor called back and told me to

write something else down which was what

hospital they would take her too (sic), driver's

names if they was going to refuse to take her (sic),

vitals from the paramedics had (sic). At 11:30 am -

11:35 am, [DSP #6] did CPR on [client A] until the





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15G599 12/14/2020

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860 W 65TH LN

00

paramedics came in. They came in and we had to

put everyone in their room (sic) at 11:45 and and

keep the client (sic) in their room (sic) until the

paramedics were here about working on her all

that time, and they took her out the house at

about 12:00 pm, and [supervisor #1] told me that

[PD #1] was walking up to the home (sic)."

The facility's Operation Practices dated December

2019 was reviewed on 12/10/20 at 11:50 am and


"2. When an individual experiences serious

sickness or injury, the direct service employee

takes the necessary emergency action and then

notifies the individual's Facility Nurse, Program

Director/on-call person, and family/guardian as

soon as possible. Individual's protocols will

instruct direct support employees of what action

to take and when to notify facility nurse. Nurse

will consult and advice (sic) for further treatment."

Client A's Gastro-esophageal ulcers protocol

dated 10/19/20 was reviewed on 12/10/20 at 10:30

am and indicated the following:

"The esophagus is the tube from the mouth to the

stomach. Gastro refers to the stomach. [Client

A's] esophageal ulcers were caused by a Candida

(yeast) infection. Gastric ulcers are the wearing

away of the lining of the stomach....

Call 911, if

- Person appears gravely ill

- You are concerned about their immediate heath

and safety

- Other (specific to the person) Be alert to

complaints of pain interpreted as heartburn

accompanied by vomiting, shortness of breath,

sweating, or fast irregular pulse; this may indicate

a heart attack. Call 911 if this occurs....

Take to ER (Emergency Room) if the following

occur:





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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

Blood in vomit or stool. This could be bright red

or look like coffee grounds. Stomach pain that

does not go away after being calm and resting.

Call 911 if:

There is sudden intense chest or stomach pain.

Persistent or projectile vomiting with or without

blood.

Choking or not able to swallow."

Client A's Hiatal Hernia Protocol dated 10/19/20

was reviewed on 12/10/20 at 10:35 am and


"A Hiatal Hernia is a protrusion (or herniation) of

the upper part of the stomach into the thorax

through a tear or weakness in the diaphragm.

[Client A] was diagnosed with a hiatal hernia

6/12/20....

Interventions (What to do if problem occurs)

....Call 911 for severe chest pain with breathing

difficulty, non-stop vomiting, or profuse

bleeding."

The facility's staff training logs were reviewed on

12/10/20 at 10:30 am and indicated the following

trainings for staff working on 11/27/20:

- DSP #7 provided electronic confirmation she had

read client A's high risk plans on 8/31/20 at 5:05

pm.

- Supervisor #1 provided electronic confirmation

he had read client A's high risk plans on 11/16/20

at 9:04 pm.

An Inservice Training Report dated 8/26/20 8:00

am to 9:00 am indicated the following staff

working on 11/27/20 were trained on client A's

aspiration and dining plan:

- DSP #5

- Program Director #1.






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15G599 12/14/2020

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860 W 65TH LN

00

pm to 5:00 pm indicated the following staff



- DSP #4

- DSP #1.

An Inservice Training Report dated 9/9/20 2:00 pm

to 2:20 pm indicated the following staff working

on 11/27/20 were trained on client A's aspiration

and dining plan:

- DSP #2.

The review did not indicate DSP #6 was trained on

client A's high risk plans.

A staff meeting agenda dated August 2020

indicated the following topics:

"Welcome

Working Together

Activities

How to Report Incidents

Our Individuals

Open Discussion."

The attendance record indicated the following

staff working on 11/27/20 were in attendance via

teleconferencing:

- DSP #4

- DSP #2.

A staff meeting agenda dated July 2020 indicated

the following topics:

"Welcome

Schedules

Summer Activities

Change of Condition Training

COVID Training

Safety Net

Customer Service Skills

Our Individuals





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15G599 12/14/2020

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860 W 65TH LN

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Open Discussion."



teleconferencing:

- DSP #4

- DSP #2

- DSP #1.

The review did not indicate DSPs #5, #6, or #7

were trained on the facility's policy to report

changes in client condition or health status.

Registered Nurse (RN) #1 was interviewed on

12/10/20 at 10:56 am. RN #1 stated, "At first, I told

them to monitor [client A] and to push fluids.

They called back and said [client A] was vomiting

a dark, chunky material. I told them it sounded like

it was old blood she was vomiting up, and they

needed to get her to the hospital. I told them to

call for an ambulance. I don't know what time it

was. I was driving in to work. It was in the

morning. I assume they called for an ambulance. I

wasn't there."

RN #1 stated, "I got a call from [PD #1] that staff

were doing CPR on her. It was less than 20

minutes later. She coded at the house. Staff did

CPR, and she went to the hospital. She did not

come home from the hospital."

RN #1 stated, "After 3 episodes of vomiting or if

there's blood or any significant material, anything

that's not normal, they should call the nurse.

There's no written protocol for vomiting. She did

have an esophageal ulcer protocol."

RN #1 stated, "I usually train the program

supervisors, and they train staff on high risk

plans. Staff should be trained on plans before

working with the individuals and should follow

the plans."





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15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

Area Director (AD) #1 was interviewed on

12/10/20 at 10:54 am. AD #1 stated, "Staff are

trained on high risk plans before they start

working with the clients. Staff should follow the

high risk plans as they are written. If it says to

call 911 or the nurse, they should do it."

This federal tag relates to complaint #IN00342683.

9-3-2(a)

483.430(e)(2)

STAFF TRAINING PROGRAM

For employees who work with clients, training

must focus on skills and competencies

directed toward clients' health needs.

W 0192

Bldg. 00



provide adequate training for staff in regards to

client A's health care needs.

Findings Include:




pm.


following:











W 0192 The facility currently trains all staff

in the individual specific needs of

each individual. All staff are trained

upon hire, prior to working with the

individual, when there is a change

of status and annually thereafter.

The Program Supervisor will be

trained to ensure that all staff are

trained prior to working with the

individuals on each of their

individual specific needs. This

includes but not limited to the

individuals health risks and plans.

In addition all staff should be

trained annually or when there is a

change to the individuals risk plan.

The Program Director will be

trained to verify that all new staff

have received this training and

when not available the Program

Director will ensure the staff are

trained in the individual’s specific

01/13/2021 12:00:00AM





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abdomen scans.





following:














needs.







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12/7/20 at 3:40 pm.





Overnight.


(sic) there any concerns? When I came in , the











to still stand up.




up.















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morning...."





































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They took over and asked what happened. they






























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names if they was (sic) going to refuse to take her,





















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Call 911, if



and safety







occur:




Call 911 if:



blood.









6/12/20....




bleeding."

The facility's staff training logs were reviewed on

12/10/20 at 10:30 am and indicated the following

trainings for staff working on 11/27/20:

- DSP #7 provided electronic confirmation she had

read client A's high risk plans on 8/31/20 at 5:05

pm.





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- Supervisor #1 provided electronic confirmation

he had read client A's high risk plans on 11/16/20

at 9:04 pm.


am to 9:00 am indicated the following staff



- DSP #5

- Program Director #1.


pm to 5:00 pm indicated the following staff



- DSP #4

- DSP #1.

An Inservice Training Report dated 9/9/20 2:00 pm

to 2:20 pm indicated the following staff working

on 11/27/20 were trained on client A's aspiration

and dining plan:

- DSP #2.

The review did not indicate DSP #6 was trained on

client A's high risk plans.

A staff meeting agenda dated August 2020

indicated the following topics:

"Welcome

Working Together

Activities

How to Report Incidents

Our Individuals

Open Discussion."



teleconferencing:

- DSP #4





01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

- DSP #2.

A staff meeting agenda dated July 2020 indicated

the following topics:

"Welcome

Schedules

Summer Activities

Change of Condition Training

COVID Training

Safety Net

Customer Service Skills

Our Individuals

Open Discussion."



teleconferencing:

- DSP #4

- DSP #2

- DSP #1.

The review did not indicate DSPs #5, #6, or #7

were trained on the facility's policy to report

changes in client condition or health status.


12/10/20 at 10:56 am. RN #1 stated, "At first, I told

them to monitor [client A] and to push fluids.

They called back and said [client A] was vomiting

a dark, chunky material. I told them it sounded like

it was old blood she was vomiting up, and they

needed to get her to the hospital. I told them to

call for an ambulance. I don't know what time it

was. I was driving in to work. It was in the

morning. I assume they called for an ambulance. I

wasn't there."

RN #1 stated, "I got a call from [PD #1] that staff

were doing CPR on her. It was less than 20

minutes later. She coded at the house. Staff did

CPR, and she went to the hospital. She did not





01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00

come home from the hospital."










the plans."








9-3-3(a)

483.440(d)(1)

PROGRAM IMPLEMENTATION

As soon as the interdisciplinary team has

formulated a client's individual program plan,

each client must receive a continuous active

treatment program consisting of needed

interventions and services in sufficient

number and frequency to support the

achievement of the objectives identified in the

individual program plan.

W 0249

Bldg. 00



implement client A's plans to prevent neglect of

client A's health care needs.

Findings include:

W 0249 W249: When the facility has

formulated a client’s individual

program plan, each client must

receive a continuous active

treatment program consisting of

needed interventions and services

in a sufficient number and

01/13/2021 12:00:00AM





01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00




pm.


following:






























abdomen scans.



frequency to support the

achievement of the objectives

identified in the individual program

plan.

All staff will be trained in

implementation of active treatment

which includes following the

individual’s risk plan protocols to

ensure their health and safety. The

facility staff will be trained on

individual specific training for all

individuals. This will include risk

protocols. The staff will be trained

to implement the protocol when an

individual is exhibiting symptoms

identified in those risk protocols.

The Program Supervisor will

monitor the documentation and

observe staff 3 times per week for

one month to ensure any illness or

behavioral instances have been

reported per policy. After that

assuming compliance has been

achieved, the Program Supervisor

will monitor documentation and

complete observations at least 2

times per week.

The Program Director will monitor

documentation and observe staff

two times weekly for one month to

ensure that illness or incidents

that occur are addressed to

ensure the individual’s needs are

being met in full as well as that

staff are implementing active

treatment including risk plans.





01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00



following:



















12/7/20 at 3:40 pm.





Overnight.


(sic) there any concerns? When I came in , the















01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00



to still stand up.




up.
















morning...."




















01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00































They took over and asked what happened. They













01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00







































names if they was (sic) going to refuse to take her,





01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00


















Call 911, if



and safety







occur:




Call 911 if:



blood.








01/20/2021PRINTED:

FORM APPROVED

OMB NO. 0938-039




A. BUILDING

B. WING

(X3) DATE SURVEY

COMPLETED


(X4) ID

PREFIX

TAG




PREFIX

TAG



DEFICIENCY)

(X5)

COMPLETION



15G599 12/14/2020

REM-INDIANA INC

860 W 65TH LN

00






6/12/20....




bleeding."


12/10/20 at 10:56 am.










the plans."








9-3-4(a)


W 0000 #IN00342683....to still stand up. 4. What did her vomit look like? Brownish chunks. It was...

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